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MS4 - Neurology > Parkinson's disease > Flashcards

Parkinson's disease Flashcards

1
Q

Multiple systemic atrophy (MSA)

A

Symmetrical impairment

Lewy body in various places (inc basal ganglia)

Autonomic dysfunction (postural hypotension)

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2
Q

Progressive supranuclear palsy

A

Symmetrical

Postural instability

Young man keeps falling

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3
Q

Corticobasal degneration CBD

A

Asymmetrical

Alien limb syndrome

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4
Q

Procyclidine

A

Anticholinergic drug

Rx of drug induced parkinsonism

Also treats other extra pyramidal SEs

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5
Q

pathophysiology of Parkinson’s disease

A
  • dopamine deficiency in substantia nigra
  • Lewy bodies found in dopaminergic cells which die
  • Lewy bodies have α-synuclein
  • this destruction disturbs the motor balance of basal ganglia
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6
Q

general symptoms/signs of Parkinson’s disease

A

TRAPPS PD

Tremor

Rigidity

Akinesia

Postural instability

Postural hypotension

Sleep disorders

Psychosis

Depression/Dementia/Drug side effects

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7
Q

features of Parkinson’s Disease tremor

A

↑ by stress, ↓ by sleep

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8
Q

features of Parkinson’s Disease rigidity

A

lead-pipe

cog-wheel

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9
Q

features of Parkinson’s Disease akinesia

A

slow initiation,

difficulty with repetitive movement,

micrographia,

monotonous voice,

mask-like face

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10
Q

features of Parkinson’s Disease postural instability

A

stooped gait with festination

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11
Q

features of Parkinson’s Disease postural hypotension

A

+ other autonomic dysfunction

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12
Q

features of Parkinson’s Disease sleep disorders

A

affects 90% of PD pts.

insomnia

excessive daytime sleepiness (due to insomnia +frequent waking)

obstructive sleep apnoea

REM sleep behaviour disorder (loss of muscle atonia during REM sleep, violent enactment of dreams)

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13
Q

features of Parkinson’s Disease psychosis

A

visual hallucinations

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14
Q

features of Parkinson’s Disease autonomic dysfunction

A
  • Combined effects of drugs and neurodegeneration
  • Postural hypotension
  • Constipation
  • Hypersalivation → dribbling (↓ ability to swallow saliva)
  • Urgency, frequency, Nocturia
  • Erectile dysfunction
  • Hyperhidrosis
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15
Q

acronym for side effects of L-DOPA

A

DOPAMINE

  • Dyskinesia
  • On-Off phenomena = Motor fluctuations
  • Psychosis
  • ABP↓
  • Mouth dryness
  • Insomnia
  • N/V
  • EDS (excessive daytime sleepiness)
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16
Q

investigations for Parkinson’s disease

A

DaTSCAN

17
Q

general management of Parkinson’s disease

A
  • MDT: neurologist, PD nurse, physio, OT, social worker, GP and carers
  • Assess disability
  • e.g. UPDRS: Unified Parkinson’s Disease Rating Scale
  • Physiotherapy: postural exercises
  • Depression screening
18
Q

medical management of Parkinson’s disease in young onset + biologically fit

A
  1. Da agonists: ropinirole, pramipexole
  2. MAO-B inhibitors: rasagiline, selegiline
  3. L-DOPA: co-careldopa or co-beneldopa
19
Q

medical management of Parkinson’s disease in biologically frail + comorbidities

A
  1. L-DOPA
  2. MOA-B inhibitors
20
Q

other drug therapies for Parkinson’s disease

A
  • COMT inhibitor
  • Apomorphine
  • Amantidine
  • Atypical antipsychotics
  • SSRIs:
21
Q

surgical management of Parkinson’s disease

A
  • interrupt basal ganglia
  • deep brain stimulation
22
Q

Examples of COMT inhibitors

A

tolcapone, entacapone

23
Q

Use of apomorphone

A
  • potent Da agonist
  • SC rescue pen for sudden “off” freezing
24
Q

Use of amantidine

A
  • weak Da agonist
  • Rx of drug-induced dyskinesias
25
Q

Use of quetiapine

A

atypical antipsychotic

Rx of PD induced psychosis

26
Q

SSRIs use in PD

A

citalopram, sertraline

  • Rx PD induced Depression
27
Q

DatScan use

A

PD is a clinical dx

But differentiating between dystonia and Essential tremor is done using DatScan

28
Q

Which drug is given with L-dopa and why

A

dopa-decarboxylase (DDC) to prevent peripheral conversion of to dopamine

29
Q

COMT- i mech of action

A

reduces breakdown of L-dopa

30
Q

MAO-B i mech of action

A

stops breakdown of endogenous dopamine in synaptic cleft

MS4 - Neurology (11 decks)

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